27 December 2017
Walnut Tree Practice, www.walnuttreepractice.co.uk, provides primary medical services to approximately 4,800 patients living in Dursley and the surrounding area. The provider is registered to deliver services from May Lane Surgery, Dursley, Gloucestershire GL11 4JN. Dursley is situated 12 miles south of Gloucester and 25 miles north of Bristol.
Data from Public Health England shows that the practice had a higher than average population of patients over 65, 23%, in comparison with the national average of 17%. The practice was situated in an area with lower deprivation with a deprivation score of 13% compared to a clinical commissioning group average of 15% and the national average of 22%.
The practice, whilst registered separately with the Care Quality Commission, shares the premises with another practice. Nursing and administrative staff are employed and shared by both practices and the practice manager has responsibility for both practices.
27 December 2017
Letter from the Chief Inspector of General Practice
This practice is rated as Outstanding overall. (Previous inspection 18/05/2015 – Good)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Outstanding
Are services well-led? - Outstanding
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Outstanding
Families, children and young people – Outstanding
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Outstanding
We carried out an announced comprehensive inspection at Walnut Tree Practice on 7 November as part of our inspection programme.
At this inspection we found:
- The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines, for example in relation to antibiotic prescribing.
- The practice encompassed a holistic approach to meet individual patient needs, particularly in relation to mental health and chronic conditions.
- Frail older people were well supported by the practice employed care coordinator and their engagement with social prescribing.
- The practice had developed innovative ways of supporting people to live healthier lives across all age groups. For example the prescribing of allotments scheme, the art and crafts programmes sourced and delivered by the practice and a health resilience programme for primary schools.
- Staff involved and treated patients with compassion, kindness, dignity and respect. The practice was above average for its satisfaction scores on consultations with GPs and nurses.
- Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- Services were tailored to meet the needs of individual people and delivered in a way that ensured flexibility and choice. For example, the practice worked collaboratively with local practices to set up a travel clinic accessed by the entire locality and delivering a sexual health clinic at their practice for the locality.
- There was a strong focus on continuous learning and improvement at all levels of the organisation. When incidents did happen, the practice learned from them and improved their processes.
- At the core of the practices ethos, was learning and development, across all staff groups.
- Feedback from patients was consistently positive and higher than local and national averages.
We saw two areas of outstanding practice:
- Patients with mental health issues were well supported within the practice and the practice had prioritised non-medical treatments in this area. For example, the practice employed an artist to run art classes within the practice for eight weekly sessions. Impact was assessed by the Warwick Edinburgh wellbeing score taken before the first session and at the last session and showed a 19% improvement in patient’s wellbeing.
- The practice had been at the centre, of the initiation and maintenance of a project called the Vale Hospital Allotments which supported people with a variety of chronic health conditions as well as those suffering from bereavement. There were 46 allotments shared between local people and patients who received an allotment prescription by their GP. The practice has seen benefits to their patients in a number of ways. For example a patient was able to reduce the number of medicines taken from 11 to two items only and reported improved wellbeing in relation to their mental health.
The areas where the provider should make improvements are:
- The practice should ensure that there are systems in place to monitor that policies are adhered to by all staff, in relation to roles and responsibilities.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice